Test Bank Interpersonal Relationships Professional Communication Skills for Nurses 7th Edition Arnold

Test Bank Interpersonal Relationships Professional Communication Skills for Nurses 7th Edition Arnold PREFACE TEST BANK with Complete Questions and Solutions. To clarify, this is the TEST BANK, not the textbook. You get immediate access to download your test bank. You will receive a complete test bank; in other words, all chapters shown in the table of contents in this preview will be there. Test banks come in PDF format; therefore, you do not need specialized software to open them. Chapter 1: Theory Based Perspectives and Contemporary Dynamics MULTIPLE CHOICE 1. When describing nursing to a group of nursing students, the nursing instructor lists all of the following characteristics of nursing except a. historically nursing is as old as mankind. b. nursing was originally practiced informally by religious orders dedicated to care of the sick. c. nursing was later practiced in the home by female caregivers with no formal education. d. nursing has always been identifiable as a distinct occupation. ANS: A Historically, nursing is as old as mankind. Originally practiced informally by religious orders dedicated to care of the sick and later in the home by female caregivers with no formal education, nursing was not identifiable as a distinct occupation until the 1854 Crimean war. There, Florence Nightingale’s Notes on Nursing introduced the world to the functional roles of professional nursing and the need for formal education. DIF: Cognitive Level: Comprehension TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity 2. The nursing profession’s first nurse researcher, who served as an early advocate for high- quality care and used statistical data to document the need for handwashing in preventing infection, was a. Abraham Maslow. b. Martha Rogers. c. Hildegard Peplau. d. Florence Nightingale. ANS: D An early advocate for high-quality care, Florence Nightingale’s use of statistical data to document the need for handwashing in preventing infection marks her as the profession’s first nurse researcher. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 3. Today, professional nursing education begins at the a. undergraduate level. b. graduate level. c. advanced practice level. d. administrative level. 1 REF: p. 1 REF: p. 1ANS: A Today, professional nursing education begins at the undergraduate level, with a growing number of nurses choosing graduate studies to support differentiated practice roles and/or research opportunities. Nurses are prepared to function as advanced practice nurse practitioners, administrators, and educators. DIF: Cognitive Level: Comprehension TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 4. Nursing’s metaparadigm, or worldview, distinguishes the nursing profession from other disciplines and emphasizes its unique functional characteristics. The four key concepts that form the foundation for all nursing theories are a. caring, compassion, health promotion, and education. b. respect, integrity, honesty, and advocacy. c. person, environment, health, and nursing. d. nursing, teaching, caring, and health promotion. ANS: C Individual nursing theories represent different interpretations of the phenomenon of nursing, but central constructs—person, environment, health, and nursing—are found in all theories and models. They are referred to as nursing’s metaparadigm. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 5. When admitting a client to the medical-surgical unit, the nurse asks the client about cultural issues. The nurse is demonstrating use of the concept of a. person. b. environment. c. health. d. nursing. ANS: B The concept of environment includes all cultural, developmental, and social determinants that influence a client’s health perceptions and behavior. A person is defined as the recipient of nursing care, having unique bio-psycho- social and spiritual dimensions. The word health derives from the word whole. Health is a multidimensional concept, having physical, psychological, sociocultural, developmental, and spiritual characteristics. The World Health Organization (WHO, 1946) defines health as “a state of complete physical, mental, social well-being, not merely the absence of disease or infirmity.” Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 6. A young mother tells the nurse, “I’m worried because my son needs a blood transfusion. I don’t know what to do, because blood transfusions cause AIDS.” Which central nursing construct is represented in this situation? a. Environment b. Caring c. Health d. Person 2 REF: p. 3 REF: p. 2 REF: p. 2ANS: D The concept of environment includes all cultural, developmental, and social determinants that influence a client’s health perceptions and behavior. Caring is not one of the four central nursing constructs. The word health derives from the word whole. Health is a multidimensional concept, having physical, psychological, sociocultural, developmental, and spiritual characteristics. The World Health Organization (WHO, 1946) defines health as “a state of complete physical, mental, social well-being, not merely the absence of disease or infirmity.” Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people. Person is defined as the recipient of nursing care, having unique bio-psycho-social and spiritual dimensions. DIF: Cognitive Level: Application REF: p. 2 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 7. The nurse performs a dressing change using sterile technique. This is an example of which pattern of knowledge? a. Empirical b. Personal c. Aesthetic d. Ethical ANS: A Empirical knowledge is the scientific rationale for skilled nursing interventions. Personal ways of knowing allow the nurse to understand and treat each individual as a unique person. Aesthetic ways of knowing allow the nurse to connect in different and more meaningful ways. Ethical ways of knowing refer to the moral aspects of nursing. DIF: Cognitive Level: Comprehension REF: p. 5 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Management of Care 8. The nurse-client relationship as described by Hildegard Peplau a. would not be useful in a short-stay unit. b. allows personal and social growth to occur only for the client. c. facilitates the identification and accomplishment of therapeutic goals. d. focuses on maintaining a personal relationship between the nurse and client. ANS: C Hildegard Peplau offers the best-known nursing model for the study of interpersonal relationships in health care. Her model describes how the nurse-client relationship can facilitate the identification and accomplishment of therapeutic goals to enhance client and family well-being. In contemporary practice, Peplau’s framework is more applicable today in longer term relationships, and in settings such as rehabilitation centers, long-term care, and nursing homes. Despite the brevity of the alliances in acute care settings, basic principles of being a participant observer in the relationship, building rapport, developing a working partnership, and terminating a relationship remain relevant. DIF: Cognitive Level: Knowledge REF: p. 10 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity 9. The identification phase of the nurse-client relationship a. sets the stage for the rest of the relationship. b. correlates with the assessment phase of the nursing process. c. focuses on therapeutic goals to enhance client and family well-being. d. uses community resources to help resolve health care issues. ANS: C Hildegard Peplau offers the best-known nursing model for the study of interpersonal relationships in health 3care. Her model describes how the nurse-client relationship can facilitate the identification and accomplishment of therapeutic goals to enhance client and family well-being. DIF: Cognitive Level: Knowledge REF: p. 10 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Management of Care 10. Abraham Maslow's needs theory is a framework that a. begins with meeting basic psychosocial needs first. b. ensures essential needs are satisfied, then people move into higher physiological areas of development. c. proposes that people are motivated to meet their needs in a descending order. d. nurses use to prioritize client needs and develop relevant nursing approaches. ANS: D Abraham Maslow's needs theory is a framework that nurses use to prioritize client needs and develop relevant nursing approaches. Maslow's model proposes that people are motivated to meet their needs in an ascending order beginning with meeting basic survival needs. As essential needs are satisfied, people move into higher psychosocial areas of development. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity 11. Which of the following statements about communication theory is true? a. Primates are able to learn new languages to share ideas and feelings. b. Concepts include only verbal communication. c. Perceptions are clarified through feedback. d. Past experience does not influence communication. ANS: C Feedback is the only way to know that one’s perceptions about meanings are valid. Human communication is unique. Only human beings have large vocabularies and are capable of learning new languages as a means of sharing their ideas and feelings. Communication includes language, gestures, and symbols to convey intended meaning, exchange ideas and feelings, and to share significant life experience. To encode a message appropriately requires a clear understanding of the receiver’s mental frame of reference (e.g., feelings, personal agendas, past experiences) and knowledge of its purpose or intent of the communication. DIF: Cognitive Level: Knowledge REF: p. 7 TOP: Step of the Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 12. In the circular transactional model of communication, a. questions are framed in order to recognize the context of the message. b. people take only complementary roles in the communication. c. the context of the communication is unimportant. d. the purpose of communication is to influence the receiver. ANS: A A circular model expands linear models to include the context of the communication, feedback loops, and validation. With this model, the sender and receiver construct a mental picture of the other, which influences the message and includes perceptions of the other person’s attitude and potential reaction to the message. DIF: Cognitive Level: Comprehension TOP: Step of the Nursing Process: All phases REF: p. 8 4 REF: p. 10MSC: Client Needs: Psychosocial Integrity 13. The nurse recognizes that feedback loops a. do not allow for correction of original information. b. are solely based on the General Systems Theory. c. do not allow for validation of information. d. allow the human system to correct its original information. ANS: D Feedback (from the receiver or the environment) allows the system to correct or maintain its original information. Feedback loops (from the receiver, or the environment) validate the information, or allow the human system to correct its original information. General Systems Theory, initially described by Ludwig von Bertalanffy (1968), focuses on process and interconnected relationships comprising the “whole.” DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity 14. Which of the following statements best represents therapeutic communication when a student discovers a client crying in bed? a. “I am the nurse who will be doing your treatments today.” b. “Will you listen to me so I can help you get better?” c. “This is what is going to happen during surgery.” d. “Can we talk about what seems to be bothering you?” ANS: D Asking about what is bothering the client is goal directed. Its purpose is to promote client well-being. “I am the nurse who will be doing your treatments today” is a statement of fact, and it ignores the client’s emotional needs. “Will you listen to me so I can help you get better?” is not goal directed and does not involve mutuality. “This is what is going to happen during surgery” is simply one way. It does not engage the client in a therapeutic manner. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 15. The central constructs of person, environment, health, and nursing are found in all nursing theories and models and are referred to as a. telehealth. b. the medical model. c. nursing’s metaparadigm. d. five core areas of competency. ANS: C Individual nursing theories represent different interpretations of the phenomenon of nursing, but central constructs—person, environment, health, and nursing—are found in all theories and models. They are referred to as nursing’s metaparadigm. These constructs are the “metalanguage” of nursing, and together they act as basic building blocks for the discipline of professional nursing. Telehealth is fast becoming an integral part of the health care system, used both as a live interactive mechanism (particularly in remote areas, where there is a scarcity of health care providers) and as a way to track clinical data. Two important outcomes are reduced health costs and increased access to care. During the last century, the bulk of professional care was delivered in acute care settings, based on the disease-focused medical model. Switching to today’s community focus recognizes the fact that chronic medical conditions account for most of today’s care, with most being treated in the community. The IOM report Health professions education: A bridge to quality (2003) calls for the restructuring of clinical education responsive to the 21st century health system transformation goals of providing the highest quality and safest medical care possible. This report identified five core areas of competency required to cross the bridge to quality. 5 REF: p. 10 REF: p. 8DIF: Cognitive Level: Comprehension REF: p. 4 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. The discipline of nursing has “a unique perspective, a distinct way of viewing all phenomena, which ultimately defines and limits the nature of its inquiry,” related to (Select all that apply.) a. principles and laws that govern the life processes, well-being, and optimum functioning of human beings, sick or well. b. patterning of human behavior in interaction with the environment in critical life situations. c. processes by which positive changes in health status are affected. d. processes by which negative changes in health status are affected. e. patterning of human behavior in interaction with the environment in every life situation. f. principles and laws that govern the life processes, well-being, and optimum functioning of human beings, in relation to wellness only. ANS: A, B, C Donaldson and Crowley characterize the discipline of nursing as having "a unique perspective, a distinct way of viewing all phenomena, which ultimately defines and limits the nature of its inquiry," related to "Principles and laws that govern the life processes, well- being, and optimum functioning of human beings, sick or well; patterning of human behavior in interaction with the environment in critical life situations; and processes by which positive changes in health status are affected." DIF: Cognitive Level: Application REF: p. 2 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance Chapter 2: Professional Guides for Nursing Communication MULTIPLE CHOICE 1. The nurse demonstrates effective communication by ensuring all of the following except a. two-way exchange of information among clients and health providers. b. making sure that unilateral information is exchanged between clients and nurses. c. making sure that the expectations and responsibilities of all are clearly understood. d. recognizing that effective communication is an active process for all involved. ANS: B Effective communication is defined as a two-way exchange of information among clients and health providers ensuring that the expectations and responsibilities of all are clearly understood. It is an active process for all involved. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 2. A preoperative assessment shows that a client’s hemoglobin level is dropping. The anesthetist orders 3 units of blood to be administered. The nurse administers the first unit before discovering that the client is a Jehovah’s Witness, as documented in the record. This is an example of a. professional conduct. 6 REF: p. 23b. a negligent act. c. physical abuse. d. breaching client confidentiality. ANS: B The nurse was negligent by not checking the record and by failure to obtain written consent from the client for the procedure. This is an example of misconduct, not professional conduct. The nurse did not intend to physically harm the patient. The nurse did not breach client confidentiality. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 3. Which of the following is a violation of client confidentiality? Reporting a. certain communicable diseases. b. child abuse. c. gunshot wounds. d. client data to a colleague in a nonprofessional setting. ANS: D Releasing information to people not directly involved in the client’s care is a breach of confidentiality. Certain communicable or sexually transmitted diseases, child and elder abuse, and the potential for serious harm to another individual are considered exceptions to sharing of confidential information. DIF: Cognitive Level: Knowledge REF: p. 37 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 4. A 16-year-old trauma victim arrives in the emergency department with a life-threatening condition and requires emergency surgery. The nurse knows that a. a parent/guardian must give consent. b. the client can give consent if she provides proof of emancipation. c. the client must first be evaluated for competency before obtaining consent. d. surgery can be performed without consent. ANS: D Surgery can be performed without consent because it is a life-threatening emergency. Normally parents or a guardian must give consent, but in a life-threatening emergency medical care can be administered without consent. Providing proof of emancipation is not necessary in a life-threatening situation. The client does not need to first be evaluated for competency in a life-threatening situation. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 5. In regard to informed consent, which of the following statements is true? a. Only legally incompetent adults can give consent. b. Only parents can give consent for minor children. c. It is not required that the client be told about costs and alternatives to treatment. d. Consent must be voluntary. ANS: D For legal consent to be valid, it must be voluntary. Only legally competent adults can give consent. Parents or legal guardians can give consent for minor children. Clients must have full disclosure about risks/benefits, including costs and alternatives. 7 REF: p. 38 REF: pp. 28-29DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 6. The client has a living will in which he states he does not want to be kept alive by artificial means. The client’s family wants to disregard the client’s wishes and have him maintained on artificial life support. The most appropriate initial course of action for the nurse would be to a. tell the family that they have no legal rights. b. tell the family that they have the right to override the living will because the patient cannot speak. c. report the situation to the hospital ethics committee. d. allow the family to verbalize their feelings and concerns, while maintaining the role of client advocate. ANS: D Allowing the family to verbalize their feelings and concerns is the most appropriate action at the time to help the family deal with their loss and come to terms with their family member’s wishes. Telling the family that they have no legal rights would not be supportive and might create hostility. The family does not have the right to override a living will. It is not the most appropriate initial course of action to report the situation to the hospital ethics committee. According to the American Nurses Association Code of Ethics for Nurses, the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. DIF: Cognitive Level: Analysis REF: p. 27 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Management of Care 7. The nurse collects both objective and subjective data. An example of subjective data is a. BP 140/80. b. skin color jaundiced. c. “I have a headache.” d. history of seizures. ANS: C Subjective data refers to the client’s perception of data and what the client or family says about the data. Objective data refers to data that are directly observable or verifiable through physical examination or tests. Blood pressure recording is objective. Jaundiced skin color observation by the nurse is objective data. A history of seizures is objective data. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 8. The nurse observes a client pacing the floor. The nurse validates an inference when speaking to the client by stating, a. “You are anxious, so let’s talk about it.” b. “Let’s try some deep breathing to help you relax.” c. “You seem anxious. Will you tell me what is going on?” d. “Clients who pace usually need to talk to a physician. Should I call yours?” ANS: C The nurse has inferred that the client is anxious but needs to ask further questions to validate the information. A nurse should not make assumptions without first confirming that the inference is correct. Deep breathing exercise is an intervention; it is not validating an inference. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: Assessment 8 REF: p. 33 REF: p. 33 REF: p. 37MSC: Client Needs: Psychosocial Integrity 9. A client who is scheduled for a bilateral inguinal hernia repair the next day is observed pacing the unit. After validating that the client is anxious about his upcoming surgery because he is afraid of pain, a relevant nursing diagnosis would be a. anxiety related to surgery. b. pain related to anxiety about surgery as evidenced by pacing. c. anxiety related to fear of postoperative pain as evidenced by pacing. d. pacing related to fear of postoperative pain. ANS: C Anxiety is the problem to be addressed. Related to connects the problem to the etiology (fear of pain). The third part of the statement identifies the clinical evidence (pacing) that supports the diagnosis. There are three parts to a nursing diagnosis, and the anxiety is related specifically to fear of pain after surgery. The problem to be addressed is the anxiety, not the pain, at this time. “Pacing related to fear of postoperative pain” contains only two parts to this statement. Pacing is the evidence, not the problem. DIF: Cognitive Level: Application REF: p. 33 TOP: Step of the Nursing Process: Nursing Diagnosis MSC: Client Needs: Management of Care 10. Which of the following is an outcome for a client with a broken leg? a. Client will develop an ambulation program within 1 month. b. Encourage client to ambulate with cast using crutches. c. Client asks, “When will I walk again?” d. Client experiences alteration in mobility related to a broken leg. ANS: A Outcomes are goals that are measurable, achievable, and client centered. Ambulation is a nursing intervention. A question from the client is not an outcome; it is a question. “Client experiences alteration in mobility related to a broken leg” is part of a nursing diagnosis. DIF: Cognitive Level: Application REF: pp. 34-35 TOP: Step of the Nursing Process: Outcome Identification MSC: Client Needs: Physiological Integrity 11. The nurse is teaching a client who is alert and oriented about the drug warfarin. When teaching the client about this drug, the nurse emphasizes the need to be consistent with Vitamin K intake, which is found primarily in green leafy vegetables. When the client’s spouse comes to visit, the client states, “I can no longer consume green leafy vegetables.” This is an example of what type of failure caused by a communication problem? a. System failure b. Reception failure c. Transmission failure d. Global aphasia ANS: B Communication problems occur when there are failures in one or more categories: the system, the transmission, or in the reception. Reception failures occur when channels exist and necessary information is sent, but the recipient misinterprets the message. System failures occur when the necessary channels of communication are absent or not functioning. Transmission failures occur when the channels exist but the message is never sent or is not clearly sent. DIF: Cognitive Level: Analysis REF: p. 23 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 912. When setting goals with a client, the nurse demonstrates which step of the nursing process? a. Assessment b. Planning c. Implementation d. Evaluation ANS: B Outcome identification occurs during the planning phase. Goals are identified during planning, not assessment. Nursing interventions are performed during the implementation phase. During evaluation, goal achievement is evaluated. DIF: Cognitive Level: Knowledge REF: p. 35 TOP: Step of the Nursing Process: Outcome Identification and Planning MSC: Client Needs: Management of Care 13. When the nurse identifies a health problem or alteration in a client’s health status that requires a nursing intervention, the nurse is performing which step of the nursing process? a. Diagnosis b. Planning c. Intervention d. Evaluation ANS: A The nursing diagnosis consists of three parts: (1) problem, (2) etiology, and (3) evidence. The problem is a statement identifying a health problem or alteration in a client’s health status requiring nursing intervention. Planning occurs after problem identification. Interventions occur during implementation. The effectiveness of the interventions is evaluated in the evaluation phase. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: Diagnosis MSC: Client Needs: Management of Care 14. When evaluating the client’s progress toward goal achievement, the nurse should ask which of the following questions? a. “Did the client tell the truth?” b. “Were the goals realistic?” c. “Did the physician diagnose the client’s condition correctly?” d. “Was the length of stay too short?” ANS: B The goals need to be realistic and achievable in the time frame allotted for the interventions to be effective. Validation of information occurs in the assessment phase. Medical diagnosis is not part of the nursing process. The nurse needs to work within the time frame allotted. DIF: Cognitive Level: Comprehension TOP: Step of the Nursing Process: Evaluation MSC: Client Needs: Management of Care 15. The plan of care serves as the structural framework for a. maintaining confidentiality. b. attaining self-actualization. c. maintaining therapeutic communication. d. providing safe, high-quality care. 10 REF: p. 34 REF: p. 33ANS: D The plan of care plan serves as the structural framework for providing safe, high-quality care. Its purpose is to provide continuity and supply a basis for interventions and documentation of client progress. Each plan of care should be individualized to reflect client values, clinical needs, and preferences. Confidentiality is defined as providing only the information needed to provide care for the client to other health professionals who are directly involved in the care of the client. The nurse can use Maslow’s hierarchy of needs to prioritize goals and objectives. Therapeutic communication helps the nurse use the nursing process. DIF: Cognitive Level: Comprehension TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 16. The nurse is caring for a client whose health has suddenly worsened. The nurse calls the health care provider. What is the best example of the nurse communicating to the health care provider using the situation part of SBAR communication? a. “The patient has developed dyspnea with audible crackles in the lungs bilaterally; oxygen saturation is 86% on room air.” b. “The patient has chronic obstructive pulmonary disease due to a long-term history of smoking.” c. “I am concerned that the patient is exhibiting signs of a pulmonary embolus due to a sudden drop in oxygenation.” d. “I would like for you to order a STAT chest x-ray because the patient has suddenly developed shortness of breath with hypoxia.” ANS: A Situation: What is going on with the client? Background: What is key information/context? Assessment: What do I think the problem is? Recommendation: What do I want to be done? DIF: Cognitive Level: Analysis REF: p. 24 TOP: Step of the Nursing Process: All phases of the nursing process MSC: Client Needs: Management of Care 17. During a routine visit, the nurse notes that a child has several bruises at various stages of healing. The child reports having fallen down. Failure to report these findings is an example of a. negligence. b. reasonable prudence. c. maintenance of confidentiality. d. HIPAA regulation. ANS: A Failing to report suspected physical or sexual child abuse is an example of a negligent act. Reasonable prudence is a nursing action that a reasonably prudent nurse would perform. In a situation where a child has several bruises, confidentiality must be breached. HIPAA regulations protect the privacy of client records. DIF: Cognitive Level: Application REF: p. 37 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Management of Care MULTIPLE RESPONSE 1. When practicing effective and correct communication, the nurse should (Select all that apply.) a. speak in a clear voice. b. be concise when providing client education. c. be concrete when communicating with clients. d. focus entirely on abstract communication techniques with clients. e. ensure that communication with clients is complete. 11 REF: p. 35f. provide courteous communication when interacting with clients. ANS: A, B, C, E, F Effective and correct communication is: clear, concise, concrete, complete, and courteous. DIF: Cognitive Level: Analysis REF: p. 23 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity Chapter 3: Clinical Judgment and Ethical Decision Making MULTIPLE CHOICE 1. Which of the following types of thinking reflects the nursing process? a. Habits b. Inquiry c. Mnemonic d. Practice ANS: B More structured methods of thinking, such as inquiry, have been developed in disciplines related to nursing. Repetitive practice does not reflect the nursing process. Memorizing does not reflect the nursing process. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 2. Which of the following personality characteristics is a barrier to critical thinking? a. Accepting change b. Being open minded c. Stereotyping d. Going with the flow ANS: C Stereotyping is a cognitive barrier to critical thinking because it interferes with the ability to treat a client as an individual. Critical thinkers recognize that priorities change continually. Being open minded is the ability to consider alternatives. Being flexible is a bridge to critical thinking, not a barrier. DIF: Cognitive Level: Comprehension TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 3. The ethical decision-making model where good is defined as maximum welfare or happiness is known as the a. utilitarian model. b. human rights based model. c. duty-based model. d. Kant’s model. ANS: A The utilitarian model is also known as the goal-based model, where the duties of the nurse are determined by what will achieve maximum welfare. In the human rights model, the client has basic rights, including the right to refuse care. In the duty-based model, rightness is determined by moral worth. The duty-based model is based on 12 REF: p. 46 REF: p. 40Kant’s philosophy. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 4. Which of the following case examples represents the ethical concept of distributive justice? a. A famous baseball player receives a heart transplant. b. An older adult who has government insurance is denied standard cancer treatment. c. During a visit to his physician’s office, a client demands antibiotics for his cold and is given a prescription. d. A client suffering from cirrhosis of the liver is placed on a transplant list. ANS: B The decision to deny expensive treatments or to deny acute care to clients older than a certain age because of scarce treatment resources is an example of the concept of distributive justice. A famous baseball player who receives a heart transplant could be an example of the concept of social worth. A client demanding antibiotics for his cold during a physician’s office visit is an example of the concept of unnecessary treatment. A client who suffers from cirrhosis and who is placed on a transplant list is an example of justice, being fair or impartial. DIF: Cognitive Level: Analysis TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 5. Personal values are defined as a. values shaped by family, religious beliefs, and years of experience. b. altruism. c. two values that are in conflict. d. values determined by commitment. ANS: A We all have a personal value system developed over a lifetime that has been extensively shaped by our family, our religious beliefs, and our years of life experiences. Altruism is a core value of professional nursing. Cognitive dissonance refers to two conflicting values. Value intensity refers to the amount of an individual’s commitment to values. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 6. A nurse values autonomy and self-determination as well as the preservation of life. This is an example of a. conceptions of the ideal. b. cognitive dissonance. c. operative values. d. commitment. ANS: B Cognitive dissonance refers to the mental discomfort felt when there is a discrepancy between what an individual already believes and some new information that does not go along with that view. It refers to the holding of two or more conflicting values at the same time. Conceptions of the ideal are conceived values. Operative values do not refer to conflicting values. Commitment refers to value intensity. DIF: Cognitive Level: Application REF: p. 46 13 REF: p. 46 REF: pp. 43-44 REF: p. 41TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 7. Which of the following statements is true about the critical thinking process? a. It is a linear process. b. The skills are inborn. c. It is goal directed. d. It assists nurses to criticize the health care system. ANS: C The process of critical thinking is systematic, organized, and goal directed. As critical thinkers, nurses are able to explore all aspects of a complex clinical situation. Critical thinking is a circular process. Critical thinking is a learned skill that teaches you how to “think about your thinking.” Critical thinking is clinical judgment, not criticism. DIF: Cognitive Level: Comprehension TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 8. Which of the following best describes the critical thinking skills of a novice nurse and an expert nurse? a. The expert nurse is able to diagnose faster than the novice nurse. b. The expert nurse does not need to question and reassess like the novice nurse. c. The novice nurse uses past knowledge, whereas the expert nurse stays in the here and now. d. The expert nurse organizes data more efficiently than the novice nurse. ANS: D The novice nurse collects lots of facts but does not logically organize them. Novice nurses tend to jump too quickly to a diagnosis without recognizing the need to obtain more facts. The expert nurse constantly questions and reassesses. The expert nurse compares new information with prior knowledge, while the novice nurse makes fewer connections to past knowledge. DIF: Cognitive Level: Comprehension TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 9. A client with schizophrenia has been stabilized on long-acting haloperidol, an antipsychotic medication that is administered by injection every 3 weeks. The physician switches the medication to Seroquel, a new antipsychotic oral medication that is administered twice a day. The client complains that he cannot afford the new medication and will not be able to remember to take it. The physician replies, “I can’t help that; I have to treat you the way I think is best.” The client’s nurse may experience a. paternalism. b. cognitive dissonance. c. nonmaleficence. d. moral distress. ANS: D Moral distress results when the nurse knows what is right but is bound to do otherwise because of legal or institutional constraints. Paternalism is making decisions for clients based on what is thought best for them. Cognitive dissonance occurs when there are two conflicting values. Nonmaleficence is avoiding actions that bring harm to another person. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 10. Characteristics of a critical thinker include all but which of the following? 14 REF: p. 47 REF: p. 45 REF: p. 49a. Haphazardly seeking solutions b. Anticipating consequences c. Considering alternative solutions d. Revising actions based on new input ANS: A This is an example of a negative style question. “Haphazardly seeking solutions” is correct because a characteristic of a critical thinker is to systematically seek solutions, not to haphazardly seek solutions. All of the other options are characteristics of a critical thinker. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 11. The best method for nurse educators to teach professional values is a. reading the ANA code. b. laissez-faire. c. role modeling. d. values clarification. ANS: C Nursing education helps a nurse to acquire a professional value system. In nursing school, the student nurse begins to take on some of the values of the nursing profession. Often, professional values are transmitted by tradition in nursing classes and clinical experiences. They are modeled by expert nurses and assimilated as part of the role socialization process during the years spent as a student and new graduate. Professional values are stated in the ANA code, but the best way to transmit them is by role modeling. Professional values are transmitted by tradition and assimilated in the role socialization process. Values clarification helps a nurse to identify and prioritize values. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 12. Which of the following describes the first step in acquisition of a value? a. There must be pride in and happiness with the choice. b. The value must be acted upon in a pattern of behavior consistent with the choice. c. The value should be the result of conscious choice. d. The value must be chosen after careful consideration of each alternative. ANS: C Professional values acquisition should be the result of conscious choice. This is the first step in values acquisition. The value must be acted upon in a pattern of behavior consistent with the choice, which occurs during the seventh criteria for acquisition of a value. Pride and happiness with the choice occurs during the fourth criteria for acquisition of a value. Careful consideration of each alternative occurs during the third criteria for acquisition of a value. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 13. The client’s values a. must coincide with those of the nurse. b. are only considered during assessment. c. influence the nurse’s interventions. 15 REF: p. 49 REF: p. 49 REF: p. 45d. are not influenced by culture. ANS: C In the planning phase, it is important to identify and understand the client’s value system as the foundation for developing the most appropriate interventions. It is not necessary for the client and nurse’s values to coincide; in fact, it is an unrealistic expectation. The client’s value system is important to consider throughout the nursing process. Values are influenced by culture and religious beliefs. DIF: Cognitive Level: Comprehension TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 14. Values clarification can be incorporated within the intervention phase of the nursing process by a. identifying ineffective family coping. b. identifying care guidelines. c. identifying client’s values. d. identifying specific nursing diagnoses. ANS: B Plans of care that support rather than discount the client’s health care beliefs are more likely to be received favorably. Your interventions include values clarification as a guideline for care. Ineffective family coping is a nursing diagnosis, not an intervention. Values are identified and then used as care guidelines. Nursing diagnosis does not occur during the intervention phase of the nursing process. DIF: Cognitive Level: Comprehension REF: p. 51 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Management of Care 15. During the third step in the critical thinking process a. new data are obtained. b. values are clarified. c. existing information is compared with past knowledge. d. the problem is identified. ANS: C During step 3, existing information is compared with past knowledge. New data are obtained in step 4. Values are clarified in step 2. The problem is identified in step 5. DIF: Cognitive Level: Comprehension REF: p. 51 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 16. The student nurse can best learn the steps in critical thinking through a. reading journals. b. classroom instruction. c. repeated practice. d. developing a mnemonic. ANS: C The most effective method of learning the steps in critical thinking is by repeatedly applying them to clinical situations. Reading journals, classroom instruction, and developing a mnemonic are not the most effective ways of learning the steps in critical thinking. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: All phases 16 REF: p. 54 REF: p. 51MSC: Client Needs: Management of Care 17. The bioethical principle of autonomy refers to a. the client’s right to self-determination. b. avoiding actions that bring harm to another person. c. a decision resulting in the greatest good or least harm. d. being fair or impartial. ANS: A Autonomy is the client’s right to self-determination. Avoiding actions that bring harm to another person refers to the principle of nonmaleficence. A decision resulting in the greatest good or least harm refers to the principle of beneficence. Being fair or impartial refers to the principle of justice. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care MULTIPLE RESPONSE 1. Which of the following is true about critical thinkers? (Select all that apply.) Critical thinkers a. are open minded. b. are able to consider alternatives. c. use a purposeful reasoning process. d. use a linear thinking process. e. are able to recognize information gaps. ANS: A, B, C, E Critical thinkers use specific thinking skills that are not rigid, and these allow the consideration of alternatives and recognition of gaps and available information. Critical thinkers do not use a linear process but constantly add new input. DIF: Cognitive Level: Knowledge TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care Chapter 4: Clarity and Safety in Communication MULTIPLE CHOICE 1. A nurse manager is teaching a group of nurses about client safety. The nurse manager teaches the nurses that safety is defined as “avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the process of health care itself.” What is the source of this definition? a. Hippocratic oath b. National Patient Safety Foundation c. American Association of Colleges of Nursing d. American Nurses Association’s Code of Ethics ANS: B The National Patient Safety Foundation defines safety as “avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the process of healthcare itself.” 17 REF: p. 45 REF: p. 42DIF: Cognitive Level: Application TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 2. When conducting an in-service on serious medical errors, the nurse teaches that nearly 70% of sentinel events are related to a. lack of education. b. inadequate resources. c. minimal rest periods. d. miscommunication. ANS: D Multiple studies have pinpointed miscommunication as a major causative agent in sentinel events, that is, errors resulting in unnecessary death and serious injury. Miscommunication is the root cause in nearly 70% of sentinel events. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 3. When working on a nursing unit, the nurse recognizes that incomplete communication errors most often occur during a. staff meetings. b. the night shift. c. a handoff procedure. d. medication administration. ANS: C It is estimated that 70% of reported errors are preventable. "Preventable" means the error occurs through a medical intervention, not because of the client's illness. Fatigue is repeatedly cited as a factor contributing to errors. The most common cause of error is incomplete communication during the very many ‘handoffs’ transferring responsibility for client care to another care provider, another unit, or agency. It is estimated that in 1 day a client may experience up to 8 handoffs. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 4. A student nurse is learning about how to reduce errors and increase safety. The nursing instructor recognizes that further teaching is warranted when the student nurse states which of the following? a. “When communicating with clients, I will be clear.” b. “I will be timely in my communication with clients.” c. “I will promote communication with clients that is ambiguous.” d. “When communicating with clients, I will ensure the client understood.” ANS: C Standardization of communication is an effective tool to avoid incomplete or misleading messages. Standardization needs to be institutionalized at the system level and implemented consistently at the staff level. Safe communication about client care matters needs to be clear, unambiguous, timely, accurate, complete, open, and understood by the recipient to reduce errors. DIF: Cognitive Level: Application TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 18 REF: p. 62 REF: p. 58 REF: p. 58 REF: p. 58